11 M-CARE: Environmental control

Mobile Training for Home and Health
Caregiver For People with Disabilities and
Older People
539913-LLP-1-2013-1-TR-LEONARDO-LMP
Module:
Environmental
control

How to adjust a home for your client’s needs?
This may include:
• Recommending widening doors and ramps
• Access to rooms and facilities –(i.e. a stair lift or
a downstairs bathroom)
• Heating system that suits your clients’ needs.
• Adapting heating or lighting controls to make
them easier to use
• Improving access and movement around the
home to enable accessibility for your client and
also for yourself

Unit 1
• Weather variations and adaptations
– Cold weather
– Hot weather
– Adjusting temperature
– Medication – hotter weather

Weather variations and adaptations
• There are certain
conditions that are plainly
influenced by weather:
cold, heat, snow, rain.
– You as a caregiver should do
your best to avoid
aggravating these
conditions by limiting the
client’s exposure to certain
types of weather. Photo by digitalart,
http://www.freedigitalphotos.net/

Cold weather
• Cold weather may promote
inactivity, something that
also causes joints to stiffen.
• If possible ask your client to
try some walking or low-
impact activities which will
provide some preparation
of the muscles before going
out.
Photo by Stuart Miles,
www.freedigitalphotos.net

Warm weather
• This affects elderly and
disabled people e.g.
those with paraplegia
and chronic health
conditions such as
vascular disease or
diabetes. Photo by samarttiw,

Medications taken for a variety of diseases and symptoms
can also interfere with one's ability to manage hotter
weather.
These medications include antipsychotic drugs commonly
given to Alzheimer's patients to:
• control agitation
• anticholinergic drugs
• tranquilizers
• sedatives (including over-the-counter sleeping pills)
• amphetamines
• diuretics and drugs to control blood pressure
• antihistamines
• some antidepressants

• A person with cognitive
impairment may not be
able to communicate
distress.
• In some cases, they may not
even "feel" the heat or
discomfort because of
changes in the brain's
abilities to process sensory
information.

Heat-related illness
• Poor circulation, heart,
lung and kidney diseases,
and high blood pressure
increase the risk for heat-
related illness.
• If the client is overweight
or underweight also
increases this risk. Photo by digitalart,

Adjusting temperature
World Health Organization recommends:
• a minimum indoor temperature of 18°C
• a 2‐3°C warmer minimum temperature for
rooms occupied by sedentary elderly and
persons with a disability
Don’t forget:
• Heating pads and warm baths can ease pain.
• Ice packs can reduce swelling.

Unit 2
• Humidity

• Keep humidity
below 50%.
• Use air
conditioning or
supplement with a
dehumidifier if
needed.

Unit 3
• Clothing needs

Overall clothing approach
• increase clothing of client, particularly by
wearing long underpants or tights with
trousers, underskirts with skirts, jackets with
overcoats, or all three of hat, scarf or gloves
• BUT: remove excess clothing when indoors

• Persons with reduced mobility that go outside should
consider:
– Most wheelchair users have a troubled “thermostat”.
• They get really hot in the summer.
• They get really cold in the winter.
• Cause: since they don't move their extremities a lot, the blood
doesn't circulate in a proper manner.
– Therefore:
• Multiple layers of clothing to protect his/her body tissues and to
minimize rapid temperature changes between indoor and outdoor
environments.
• Use of (bilateral) zip pants as they are very useful.
– Also makes toilet transfers very manageable.
• If the individual cannot perform self transfers and cannot dress
him or herself at all, the best wheelchair clothing items are the
open back garments that are easy for the caregiver to use and that
are comfortable for the wearer.
• Pushing gloves, sleeve protectors, cape with sleeves, etc.

Important!
• Be aware that some wheelchair users don't
have sensation, hence they cannot feel their
body or their extremities.
– This is very important when you dress them,
especially when you put on their shoes.
– You have to ensure that the toes are straight and
that the shoe fits well.
– You have to be careful because they cannot feel
pain.

Source: http://www.essentialaids.com/

Older people
• Older persons are less able to
maintain core temperature during a
cold challenge: lower heat
production and higher heat loss.
• When at rest in the cold, older
persons have a lower metabolic rate
and a higher skin thermal
conductivity.
• They tend to overdress—they don't
feel heat the same way like young
people.
• Older skin also becomes thinner and
offers less protection from the sun.
Photo by Ambro,
www.freedigitalphotos.net

Unit 4
• The impact of weather on health
– Muscle cramps
– Lung diseases
– Lupus
– Osteoporosis
– Raynaud's Phenomenon
– Pulmologic diseases

Muscle cramps
• The risk of muscle
cramping increases
when an exercise
activity is pursued
without an adequate
warm-up.
• It is very important to
do warm-up stretches
and get muscles of your
client ready to work
before s/he begin.
Photo by stockimages,

Lung diseases
• Cold weather may also affect people with
certain lung diseases.
• Asthma may be triggered in some people by
physical activity in cold weather.
• Rheumatoid lung disease is characterized by
shortness of breath, chest pain, cough and
fever.
– For people with rheumatoid lung disease, winter
air may aggravate issues with breathing.

Systemic Lupus Erythematosus
• Lupus can have a tendency to be
activated by exposure to sunlight,
a feature referred to as,
'photosensitivity.‘
• Since ultraviolet light can trigger
and worsen flare-ups of lupus that
may involve a person's skin or
joints and other organs, people
with lupus should avoid exposure
to the sun.
• Sunscreens and clothes that cover
the extremities are important.
Wikipedia

Osteoporosis
• Icy steps and walkways can present a particular
danger to people with fragile bones.
• Slipping and falling can cause painful fractures that
may be slow to heal, or even be disabling.
• Make sure there are handrails which keep sidewalks
free of ice and snow and avoid wearing shoes with
slippery soles.
• If your client takes medication that can affect his/her
balance or stability, you may ask his/her doctor about
the possibility of changing the medication or the
timing of medication, so that they are less likely to
interfere with his/her daytime activities.

Raynaud's Phenomenon
• People with Raynaud's phenomenon should
minimize their exposure to extremes of
temperature, especially cold, as well as rapid
changes in temperature.
• They may also benefit by living in
environments that are warmer.

Pulmologic diseases
• If your client has difficulties with breathing, try a
face mask when s/he needs to go out in the cold.
• The masks cover his/her mouth and then s/he
may use the heat from his/her own breathing to
warm air before it enters his/her lungs.
• Avoid alcohol, nicotine and caffeine because they
have a drying effect on cartilage.
• Ask your client to get plenty of sleep, it restores
his/her energy and can better manage pain. It
also rests his/her joints to reduce swelling and
pain.

• It is important that your client stays hydrated
by drinking plenty of water, juice and other
liquids.
• Water is a good replacement therapy.
• It helps to flush out toxins that can cause pain
in joints with arthritis for example.
• Keep a Pain Diary: Write about the level of
pain your client experiences at different times,
how s/he is feeling, as well as what activities
s/he can and cannot do.

Unit 5
• Security
– Anti-theft
– Fire safety

Before you leave the house with the client:
• Windows
– Secure all accessible windows with secondary blocking devices
– Block accessible windows so they cannot open more than 6 inches for
ventilation
– Make sure someone cannot reach through an open window and unlock the
door
– Make sure someone cannot reach inside the window and remove the blocking
device;
– Use anti-lift devices to prevent window from being lifted out
• Lights
– Interior lighting is necessary to show signs of life and activity inside a
residence at night.
– Consider light timers or photo-cells to turn on/off lights automatically.
• Alarms
– Alarm systems are effective deterrents with visible signage.
– Alarm systems to be properly installed, programmed, and maintained.
• Neighbours
– Get to know neighbours on each side of the clients’ home. Communicate
often, and establish trust.

Fire safety
• Warning
– Are there smoke detectors and are they working? The
batteries should be checked periodically.
• Emergency plans
– Know the emergency plan for how to exit the home in an
emergency.
– Plan an alternative exit route.
• Prevention
– Is there a fire extinguisher?
– Never leave cooking unattended on the stove.
– Encourage appropriate smoking habits.
– Never allow smoke in bed.
– Smoking should NEVER be allowed around oxygen bottles.

In case of fire (“RACE formula”)
• Remove any people in direct danger
• Alarm by calling the fire department (112)
• Contain the fire by closing doors and windows
• Extinguish the fire if possible or evacuate if
needed

Unit 6
• Set Assistive technologies ready for usage
– Overview – Hearing aids
– Overview – Mobility aids
– Overview – Healthcare aids
– Overview – Household aids
– Overview – Assistive Technology
– Interesting sites on supportive/assistive
technologies
– Useful Assistive technologies

What to consider?
• As a caregiver, you should be aware of the range of products and
services that exists and that can help the client to improve his/her
daily life
• Be aware of the local stores that have aids in following areas
– Mobility
– Hearing
– Vision
– Hygiene
– Bedroom
– Household
– Dressing
– Home Healthcare
– Work & Leisure
– Comfort
– Orthopaedic
You, as PCG, might
identify an issue your
client faces, which
could be easily
addressed with a
supporting aid.

Overview – Vision aids
• Watches
• Magnifiers
• Clocks & Timers
• Magnifying Lamps
• Calculators/Record
Keeping
• Writing/Money
management
• Canes & GPS
• Braille & Blindness Aids
• Labelling & Marking
• Reading
Glasses/Sunglasses
• Bibles & Dictionaries
• Games & Education
• Electronic
Magnification
• Systems
• Telephones
• Telephone Accessories

Overview – Hearing aids
• Bluetooth Cell
Amplifiers
• Telephone Headsets
• Telephone Ring
Amplifiers & Visual
Alerts
• Personal Amplifiers
• TV Amplifiers
• Voice Amplifiers
• Hearing Aid Dryers
• Vibrating Clocks &
Watches
• Timers
• Tinnitus & Hearing Aid
Batteries
• Hearing Aid
Maintenance
• Amplified Telephones

Overview – Mobility aids
• Canes
• Rollators
• Walkers
• Support/Transfer Aids
• Bathroom Aids

Overview – Healthcare aids
• Blood Pressure Monitors
• Scales/Thermometers
• First Aid/Massagers
• Pill Accessories
• Medication Reminders
• Diabetic Aids

Overview – Household aids
• Lamps & Lighting
• Reading Accessories
• Kitchenware
• Daily Living Aids

Overview – Assistive Technology
• Computer Accessories & Software
• Recorders/Players
• Reading Machines/Scanners

Interesting sites on
supportive/assistive technologies
• Aids for usage in the home environment:
www.essentialaids.com /
www.thuiszorgwinkel.be
• European Assistive Technology Information
Network - www.eastin.eu
• Institut Der Deutschen Wirtschaft Köln -
www.iwkoeln.de
• Flemish Agency For Persons With Disability -
www.vaph.be

Useful Assistive technologies
• Independent living aids (easy-to-grip cutlery,
reaching tools, elastic shoelaces and long-
handled brushes)
http://www.independentliving.com/

• Medication aids like
pill organizers and
timers to remind
people to take their
medicine
Source: http://www.containerstore.com/

Safety and security devices:
• intercom systems,
• occupancy monitors that activate when the
person using them gets up from a chair or bed
Onsetcomp.com
occupancy/light logger

• For those in the early
stages of dementia there
are memory aids, like
jumbo, analogue wall
clocks and voice-activated
phone dialers.
Memory Game- Modern Menagerie

Unit 7
• Vacuum cleaning
• Dusting

Vacuum cleaning
• Once or twice per week,
preferably when client is not
present.
• Wearing a mask may help if
client does vacuuming
him/herself.
• Preferably use vacuum
cleaners with HEPA (High
Efficiency Particulate
Arrestance) filters or high
filtration bags.
Photo by artur84,

Do’s and don’ts of vacuuming
• Do vacuum regularly. Once
a week is the minimum,
but twice a week would be
best.
• Do move furniture.
• Do vacuum under beds.
• Do vacuum both ways: up
and down and side to side.
• Do also the edges.
• Do use the vacuum tools
to reach those tiny spots.
• Don’t rush.
• Don’t let the bag get too
full, a bag that is
overfilled loses suction
and effectiveness.
• Don’t just vacuum the
floors.

Do’s and don’ts of dusting
• Use damp method one or two times per week.
• Before you begin dusting, it’s important to remove all items from
every surface.
• There are several different cleaning tools you can use to dust
your office.
– A damp dust rag can be used to wipe down counter tops and desk
top surfaces.
– A feather duster is good for reaching high areas such as the ceiling,
tops of shelves or filing cabinets, overhead ceiling vents, etc.
• Start dusting the high surfaces of your room first.
• If you are having a hard time dusting those inconvenient spots,
try using different dusting tools such as a vacuum or paint brush.
• Don’t move onto another room until you’ve finished dusting
every surface in the room you started in.

References:
• Aging families and caregiving / Sarah Honn Qualls; Steven H Zarit 2009, English Book xiii, 338 p. : ill.
; 25 cm. Hoboken, N.J. : John Wiley & Sons, ; ISBN: 9780470008553
• The real truth about aging : a survival guide for older adults and caregivers / Neil
Shulman; Michael A Silverman; Adam G Golden2009 ,English Book p. cm. Amherst, N.Y. :
Prometheus Books, ; ISBN: 9781591027195
• Aging Families and Caregiving by Sara Honn Quall, Steven H. Zant, Eds. 2009, English Book , (338 p.)
Wiley: (January 27, 2009) ISBN: 10: 0470008555
• http://www.nfcacares.org/who_are_family_caregivers/
• http://www.nfcacares.org/pdfs/AARPSurveyFinal.pdf
• http://www.womenshealth.gov/faq/caregiver-stress.cfm#a
• http://www.womenshealth.gov/faq/caregiver-stress.cfm#a
• http://aspe.hhs.gov/daltcp/reports/ltcwork.htm
• http://www.healthcalculators.org/calculators/caregiver.asp
• http://www.co.rock.wi.us/Dept/Aging/CaregiverBooks.htm
• http://seniorliving.about.com/od/lifetransitionsaging/a/agingwellbooks.htm
• http://www.caregivingcafe.com/blog/wp-content/uploads
• http://seniorcarepartners.wordpress.com/our-caregivers/

11 M-CARE: Environmental control

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